Atrial Septal Defect Clinical features Physical Exam with Treatment

                   Ostium secundum atrial septal defect

Most common is ostium secundumASD, located at mid interatrial septum. It is a simple and common type of ASD with shunt from LA to RA. Usually asymptomatic and acyanotic in children and young adults.

Atrial Septal Defect Clinical features

• More common in females Presents usually in fourth decade.
• May present in infants, with features of left-to-right shunt i.e. dyspnoea, fatigue, recurrent lower respira­tory tract infections.
• Adults have left ventricular failure
• Atrial arrhythmias – atrial fibrillation is common JVP is normal or raised.
• There is hyperdynamic right ventricular impulse. Di­rated pulmonary artery may give rise to systolic old J­sation over the left second intercostal space.
• There is a split first heart sound with loud Tl.
• Talere is grade 2 or 3 pulmonary ejection systolic murmur.
• There is wide fixed splitting of‘second heart sound.
• There is tricuspid mid diastolic flow murmur in the
• tricuspid area.

Atrial Septal Defect Physical Exam

• Infants and children with ASDs tend to be small for their age, even in the absence of complicating factors such as heart failure or other cardiac malformations
• Signs vary according to extent of shunting:
• Prominent precordial bulge
• large left-to-right shunt may result in a precordial bulge due to atrial enlargement
• Palpable pulmonary artery pulse
• An enlarged and pulsatile pulmonary artery may be palpated at the second left intercostal space.
• Pulmonic flow murmur: Systolic ejection murmur
• Low-pitched diastolic murmur at left lower sternal border
• Right ventricular lift
• Fixed, widely split S2
• characteristic finding in ASDs with large left-to-right shunts and normal pulmonary artery pressure is wide, fixed splitting of the second sound (S2)
• Cyanosis and clubbing (with severe pulmonary hypertension: Eisenmenger syndrome)

Atrial Septal Defect ECG

• Ostium secundum: Rightward axis, right ventricular hypertrophy, rSR’ pattern in V1
• Shows peaked P waves, rSR or Rs pattern in lead Vl ue to left atrial enlargement and right ventricular ypertrophy.
• Sinus venosus: Leftward axis, inverted P wave in lead III
• Note: All may be associated with PR prolongation.

Atrial Septal Defect X-ray

• Chest x-ray: Varying degrees of cardiac enlargement, increased pulmonary vascular workings, right ventricle and pulmonary artery enlargement
• Shows increased pulmonary arterial vascularity, small ascending aorta, large dilated pulmonary trunk and its branches, dilated right atrium and right ventricle.
• Echocardiography: Pulmonary arterial and right ventricular dilatation and anterior systolic (paradoxical) septal motion

Atrial Septal Defect Treatment

• Appropriate health care: Referral to a cardiologist for evaluation
• Majority of small ASDs will close spontaneously; however, close follow-up is warranted
• Closure is usually delayed until preschool age (2–4 years), except for large defects to be repaired earlier.
• Closure via percutaneous transcatheter device or surgery